Streamers Country Ceramics

1 Hazelwood Dr. * Baltic, CT 06330
PHONE in Orders: "Toll free USA"- 1-888-345-1114
From outside the USA phone (860) 822-9151

CUSTOMER NAME:_____________________________________________________

ADDRESS:____________________________________________________________

CITY-STATE-ZIP:_______________________________________________________

PHONE: (________)_______________________ e-mail:_________________________________


-Quantity- --Item Number-- ---Description or optional information--- ---Price Each--- ---Total Price---
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SUB TOTAL $
Connecticut residents add 6% sales tax $
Needed if paying by check.(See order page) SHIPPING $
TOTAL AMOUNT $

Method of payment:
___ Check or Money Order - Payable to Streamers Country Ceramics (US funds only)
( Visa - Master - Discover ) Please Mark one!
___ Credit Card - Account #:_________________________________ Exp date:_______ CVS(Last-3 #'s on back):_______
AUTHORIZED SIGNATURE ______________________________________________